PDF(Pubmed)
Abstract：
BACKGROUND: Approximately 10% of European children are classified as allergic to drugs. In the majority of these children, no allergy to β-lactam antibiotics (BLA) can be found. In most cases, the exanthema is caused by the infection.
METHODS: The objective of this paper is to describe the causes and consequences of a misdiagnosis of drug allergy. We propose a method for establishing a correct diagnosis in the case of a history of a delayed reaction during treatment with a BLA. For this purpose, a proposal was discussed via e-mail communication, and consensus was reached among the members of the drug allergy working groups of the participating medical societies.
RESULTS: The suspicion of a BLA allergy based on the medical history alone can have a negative impact on future antibiotic treatment. Exanthema associated with febrile infections not related to drug administration is a frequent finding in children. This makes it all the more important to be able to recommend a standardized procedure for clarification in children and adolescents with suspected hypersensitivity reactions. The medical history should be the basis on which to diagnose either a drug allergy or another possible differential diagnosis. A mild maculopapular exanthema (MPE) can be an expression of a drug allergy or a nonspecific viral exanthema. Uncomplicated MPE is not associated with significant systemic involvement, and there is no involvement of the mucous membranes or cutaneous blistering. Only a small number of children with uncomplicated MPE show positive skin tests and only ~ 7 - 16% of suspected BLA diagnoses can be confirmed by provocation tests. Thus, in children with uncomplicated MPE, drug provocation can be performed in an outpatient setting even without prior skin testing. This paper presents a 3-day outpatient direct provocation scheme for BLA delabeling in children with uncomplicated MPE.
CONCLUSIONS: Many children and adolescents are unnecessarily denied treatment with BLA after an uncomplicated MPE while being treated with a BLA.
METHODS: The objective of this paper is to describe the causes and consequences of a misdiagnosis of drug allergy. We propose a method for establishing a correct diagnosis in the case of a history of a delayed reaction during treatment with a BLA. For this purpose, a proposal was discussed via e-mail communication, and consensus was reached among the members of the drug allergy working groups of the participating medical societies.
RESULTS: The suspicion of a BLA allergy based on the medical history alone can have a negative impact on future antibiotic treatment. Exanthema associated with febrile infections not related to drug administration is a frequent finding in children. This makes it all the more important to be able to recommend a standardized procedure for clarification in children and adolescents with suspected hypersensitivity reactions. The medical history should be the basis on which to diagnose either a drug allergy or another possible differential diagnosis. A mild maculopapular exanthema (MPE) can be an expression of a drug allergy or a nonspecific viral exanthema. Uncomplicated MPE is not associated with significant systemic involvement, and there is no involvement of the mucous membranes or cutaneous blistering. Only a small number of children with uncomplicated MPE show positive skin tests and only ~ 7 - 16% of suspected BLA diagnoses can be confirmed by provocation tests. Thus, in children with uncomplicated MPE, drug provocation can be performed in an outpatient setting even without prior skin testing. This paper presents a 3-day outpatient direct provocation scheme for BLA delabeling in children with uncomplicated MPE.
CONCLUSIONS: Many children and adolescents are unnecessarily denied treatment with BLA after an uncomplicated MPE while being treated with a BLA.
摘要：
背景：大约10％的欧洲儿童被归类为对药物过敏。在大多数这些孩子中，没有发现对β-内酰胺类抗生素（BLA）过敏。在大多数情况下,皮疹是由感染引起的。
方法：本文的目的是描述药物过敏误诊的原因和后果。我们提出了一种在BLA治疗期间有延迟反应史的情况下建立正确诊断的方法。为此,通过电子邮件通信讨论了一项提案，与会医学会药物过敏工作组成员达成共识。
结果：仅根据病史怀疑BLA过敏可能会对未来的抗生素治疗产生负面影响。与高热感染相关的皮疹与药物管理无关，在儿童中经常发现。这使得能够推荐一种标准化程序来澄清怀疑有超敏反应的儿童和青少年变得更加重要。病史应该是诊断药物过敏或其他可能的鉴别诊断的基础。轻度斑丘疹性皮疹（MPE）可以是药物过敏或非特异性病毒性皮疹的表达。简单的MPE与明显的系统参与无关，并且没有粘膜或皮肤起泡的参与。只有少数患有不复杂的MPE的儿童表现出积极的皮肤测试，只有约7-16％的可疑BLA诊断可以通过激发测试得到证实。因此，在患有简单MPE的儿童中，即使没有事先进行皮肤测试，也可以在门诊进行药物激发。本文提出了一项为期3天的门诊直接激发方案，用于无复杂MPE儿童的BLA脱标签。
结论：许多儿童和青少年在接受BLA治疗时，在无并发症的MPE后，不必要地拒绝接受BLA治疗。
方法：本文的目的是描述药物过敏误诊的原因和后果。我们提出了一种在BLA治疗期间有延迟反应史的情况下建立正确诊断的方法。为此,通过电子邮件通信讨论了一项提案，与会医学会药物过敏工作组成员达成共识。
结果：仅根据病史怀疑BLA过敏可能会对未来的抗生素治疗产生负面影响。与高热感染相关的皮疹与药物管理无关，在儿童中经常发现。这使得能够推荐一种标准化程序来澄清怀疑有超敏反应的儿童和青少年变得更加重要。病史应该是诊断药物过敏或其他可能的鉴别诊断的基础。轻度斑丘疹性皮疹（MPE）可以是药物过敏或非特异性病毒性皮疹的表达。简单的MPE与明显的系统参与无关，并且没有粘膜或皮肤起泡的参与。只有少数患有不复杂的MPE的儿童表现出积极的皮肤测试，只有约7-16％的可疑BLA诊断可以通过激发测试得到证实。因此，在患有简单MPE的儿童中，即使没有事先进行皮肤测试，也可以在门诊进行药物激发。本文提出了一项为期3天的门诊直接激发方案，用于无复杂MPE儿童的BLA脱标签。
结论：许多儿童和青少年在接受BLA治疗时，在无并发症的MPE后，不必要地拒绝接受BLA治疗。
